Project Summary The candidate proposes a career development Pathways to Independence award to further develop research skills in the area of biobehavioral clinical research. Each aim of the proposal is supported by didactic coursework, research training experiences, scientific meetings and seminars including a detailed dissemination plan. The candidate's ultimate career goal is to become an independent scientist focused on improving care and outcomes of the mechanically ventilated critically ill. Ventilator-associated pneumonia (VAP) is an acute care complication with high morbidity and mortality, which increases length of stay and health care resources used. The purpose of the proposed K99 research project is to evaluate exhaled biomarkers and nursing care factors in the mechanically ventilated population to obtain a better understanding of pulmonary infection in the mechanically ventilated critically ill population. The primary aim is to evaluate relationships of exhaled biomarkers, systemic biomarkers and pulmonary infection in critically ill MV patients. The secondary aim is to examine nursing care factors (positioning and pulmonary hygiene) in these patients and the relationship between those factors and exhaled breath composition, exhaled biomarkers and pulmonary infection. Plasma and exhaled breath samples will be collected from endotracheally intubated adults for biomarker analysis which will be assessed for agreement and association with pulmonary infection scores. Additionally, nursing care factor (positioning and pulmonary hygiene) data will be collected and assessed for association with exhaled biomarkers and pulmonary infections scores. The overall goal of this research proposal is to provide the candidate with a foundation in biomarker analysis and knowledge of nursing care factors that are associated with pulmonary infection and advance the candidate's research program aimed at improving pulmonary health outcomes of the critically ill. Additionally, by understanding the effect of nurse-directed care on exhaled biomarkers and pulmonary infection in mechanically ventilated patients, this study will provide foundational insight into the pathological significance of these therapies and may generate future clinically relevant research hypotheses.